Provider Demographics
NPI:1104991975
Name:BOHLMAN, ANN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:BOHLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 MONONA DR.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716
Mailing Address - Country:US
Mailing Address - Phone:608-223-1506
Mailing Address - Fax:608-223-1745
Practice Address - Street 1:4915 MONONA DR
Practice Address - Street 2:SUITE 305
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-2665
Practice Address - Country:US
Practice Address - Phone:608-223-1506
Practice Address - Fax:608-223-1745
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7018-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI04154B102Medicaid